Baltimore Peripheral Nerve Surgeon Dr. Eric H. Williams Explains Why Groin Pain After Surgery for a Hernia Repair Can Indicate Nerve Damage
Most patients who have hernia repair surgery find that the operation relieves their pain and allows them to resume their regular daily activities. However, a significant number continue to struggle with groin pain that is caused by nerve damage. Baltimore peripheral nerve surgeon Dr. Eric H. Williams has helped many patients with groin pain after hernia surgery find relief—and he may be able to do the same for you.
Is it Normal to Have Pain Months After Hernia Surgery?
With any surgical procedure, you may experience some pain during the recovery period. However, your pain should continue to decrease as your body heals.
Pain that continues six months or more after hernia surgery is not normal. However, it’s not uncommon. About 3% to 5% of patients with a hernia repair have chronic pain following surgery. Nerve damage following hernia surgery is formally known as post-herniorrhaphy neuralgia.
Causes of Nerve Damage Related to Hernia Repair Surgery
Some potential causes of post-herniorrhaphy neuralgia include:
- The implantation of mesh. The use of surgical mesh in hernia repair can lead to increased inflammation in the surrounding tissues. This heightened inflammatory response often results in the formation of scar tissue. Scar tissue can be problematic because it may compress, irritate, or entrap nearby nerves.
- Trauma to the nerves during dissection. The surgeon must separate tissues to reach the hernia. Nerves can accidentally be damaged during this process.
- Neuroma formation. A neuroma is a growth that can develop in a nerve after nerve injury. In the context of hernia repair, if a nerve is damaged during the surgery, it can lead to the formation of a neuroma. Many neuromas are very painful.
- Nerve entrapment by sutures. When closing a surgical wound, surgeons use sutures (stitches) to hold the tissue together. Occasionally, these sutures can inadvertently entrap nearby nerves.
- Postoperative adhesions. Adhesions are bands of scar tissue that can form between tissues and organs after surgery. They can cause chronic pain by tethering nerves or by causing tension when the body moves.
Nerves that are the most commonly affected by inguinal hernia repair surgery include:
- Ilioinguinal nerve. This nerve runs along the inguinal canal and provides sensation to the upper part of the inner thigh, the root of the penis and the upper part of the scrotum in men, and the mons pubis and labia majora in women.
- Iliohypogastric nerve. This nerve provides sensation to the skin of the lower abdomen and the upper lateral parts of the thigh.
- Genitofemoral nerve. This nerve has two branches: the genital branch, which provides sensation to the skin of the scrotum and testicle in men and the labia majora in women. The femoral branch of the genitofemoral nerve supplies the skin on the upper part of the front of the inner thigh.
Symptoms of Hernia Surgery Nerve Damage
The specific symptoms of nerve damage after hernia surgery can vary depending on which nerves are affected and the severity of the damage. However, the most common symptoms include:
- Chronic pain. This pain can range from mild to severe and may be described as sharp stabbing, burning, aching, or electrical shooting.
- Numbness or tingling. You might experience a loss of sensation or a "pins and needles" feeling in the area affected by the nerve damage.
- Sensitivity to touch. The area around the surgical site might become extremely sensitive to touch, even to the point where it is painful to wear underwear. Oftentimes, it is the lighter touch that hurts even more than deliberate touch.
- Difficulty with everyday activities. In some cases, chronic pain after inguinal hernia surgery can interfere with your ability to walk, sit, stand, squat, sleep, or enjoy sexual activity.
It is important to keep in mind that experiencing a nerve injury after hernia surgery doesn't automatically imply that your surgeon was negligent. Surgery inherently carries risks, and not every nerve injury necessitates legal action. Remember, we stated that 3% to 5% of all patients having hernia repairs will experience some sort of neuropathic pain. This means every surgeon doing hernia repairs will have a problem at some point, no matter how careful they are.
Complications, including nerve injuries, can arise even when surgeons employ the highest standard of care. Surgery, by its nature, is invasive. This is why patients are asked to sign consent forms before a procedure.
Diagnosing Nerve Damage After Inguinal Hernia Repair Surgery
If you have chronic pain in your groin after surgery to repair an inguinal hernia, you should first discuss your concerns with the doctor who performed your surgery to make sure the hernia was repaired correctly, and you’re healing as expected. Then, if you’re not satisfied, seek a second opinion from a different surgeon who is not affiliated with the facility where you had your initial procedure performed.
If both doctors confirm there are no identifiable issues with your hernia repair surgery, the next step would be to have diagnostic nerve blocks done on the ilioinguinal nerve, iliohypogastric nerve, and genitofemoral nerve. If these nerve blocks temporarily relieve your pain, other options for treatment are available. These options include physical therapy, medical pain management, nerve stimulation, or surgical treatment to address the injured nerves. As a surgeon, Dr. Williams focuses on the surgical management of chronic groin pain after hernia repair, as most patients who see him have already exhausted other less invasive treatment options.
How a Peripheral Nerve Surgeon Treats Nerve Damage From Hernia Surgery
The specific approach used to treat groin pain from hernia surgery depends on the type and extent of nerve damage. Often, Dr. Williams will remove the ilioinguinal, iliohypogastric, and genitofemoral nerves and bury them in the abdominal wall while leaving the mesh hernia repair in place. This is generally an outpatient procedure that takes one to two hours for each side. Typically, Dr. Williams can reuse the original incision in the groin—although it may need to be extended in some cases.
If a patient has had a laparoscopic hernia repair, this can be a more challenging situation. It can still be successfully addressed, though the nerves may need to be removed inside the pelvis rather than outside the pelvis.
After surgery, you’ll need to use an ice pack and rest for a few days. However, you should be able to walk and sit normally. Dr. Williams can answer any questions you have about what to expect during the recovery process, but most people find it is easier than recovering from the original hernia repair surgery.
Addressing Chronic Pain From Hernia Surgery Will Not Limit Your Sexual Function
One of the most common concerns we hear from patients with nerve damage following a hernia repair is that additional surgery will affect their sexual function. Fortunately, this worry is unfounded. If anything, our patients find that no longer being in chronic pain makes sex more enjoyable.
When a nerve needs to be removed to relieve pain, this results in numbness. However, the numbness in your groin area tends to shrink over time and should not have any effect on sexual pleasure. The nerves that cause chronic pain following inguinal surgery are not the same as those that control your sexual function and pleasure.
How Dr. Williams Can Help
Every case is different, but Dr. Williams has found that 85% of his patients have “good to excellent” results. Hernias repaired with an open approach have a more straightforward recovery than those that are repaired laparoscopically.
Here are some examples of how we’ve helped people just like you find relief from chronic groin pain after hernia surgery:
- Complete resolution of pain. Our male patient experienced more than a year of severe pain in the groin and testicle after his hernia repair. Dr. Williams removed the ilioinguinal, iliohypogastric, and genitofemoral nerve laparoscopically and decompressed the lateral femoral cutaneous nerve. Our patient has had essentially complete resolution of his pain.
- Able to resume intimacy. Our male patient had an inguinal hernia repair and suffered from unbearable groin and testicular pain following the otherwise successful repair for one year before he saw Dr. Williams. Wearing clothing was painful and intimacy with his wife was nearly impossible before removing the ilioinguinal, iliohypogastric, and genitofemoral nerve. He is now much happier, with near complete resolution of his groin and testicular pain.
- No more need for medication. Our female patient had pain in her groin and pubic region for two years after an inguinal hernia repair. We removed several sensory nerves to the groin including the ilioinguinal, iliohypogastric, and genital branch of the genitofemoral nerve. After surgery, she was able to stop all her medications and resume her previous activities with little or no pain.
You can learn more about the results Dr. Williams has been able to achieve with his patients on the testimonials section of our website.